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ARDS MANAGEMENT ,PRONE POSITIONING & NURSES ROLE murugesh

it explains you about meaning of term ARDS, stages, pf ratio caluculation, ARDS staging, management , ECMO, PRONE POSITIONING, NURSING INTERVENTIONS ETC.....

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ARDS MANAGEMENT ,PRONE POSITIONING & NURSES ROLE murugesh

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  1. ARDS MANAGEMENT ,PRONE POSITIONING & NURSES ROLE BY MURUGESH H J ICU 02 NURSING STAFFS KFCH HOSPITAL JIZAN (AL HAYATH)

  2. ARDS • ACUTE RESPIRAORY DISTRESS SYNDROME DEFINED AS A - • “ SYNDROME OF ACUTE & PERSISTENT LUNG INFLAMMATION WITH INCREASED VASCULAR PERMEABILITY (HANSEN –FLETCHER ET AL)” • AS WE KNOW ITS AN ACUTE LUNG CONDITION IN WHICH PERSON SUSCEPTIBLE TO GET RESPIRATORY FAILURE/ARREST ; MAY LEEDS TO CARDIAC ARREST & DEATH ……….. • LUNG INFECTION(FLUID BUILD UP)----LUNG PARENCHYMAL DESTRUCTION(INFLAMMATION ) ----ARDS---RESPRATORY FAILURE/ARREST----CARDIAC ARRSET –DEATH

  3. ARDS • Clinically ARDS is characterized by: • Acute onset ( <48hrs) • Bilateral lung infiltrates • Pao2/fio2 ratio <300mmhg • No evidence of cardiac CAUSES • CONSTANTLY RISING HIGH PEEP & FIO2 (PEEP >10 & FIO2 >95% )……

  4. ARDS :: • CAUSES – • DIRECT LUNG INJURY –Pneumonia, aspiration, inhalation injuries, RTA,Near Drowning etc……. • INDIRECT LUNG INJURY –Sepsis, massive blood transfusion etc…. STAGES–( By Severity pao2/ Fio2 ratio) 1.MILD ARDS (200-300mmhg) 2.MODERATE ARDS (100-200mmhg) 3.SEVERE ARDS (<100MMHG )

  5. PF RATIO- • PF RATIO =Partial pressure of oxygen / fraction of inspired oxygen ( pao2/fio2 ) Example pao2 is 147 , fio2 is 50% ( 0.5) , Pf ratio= 147/0.5 i.e 294 … Pf ratio is 294 so its mild ARDS ……….

  6. DIAGNOSIS- • ***EXAMINATION OF THE AIR WAY– Auscultation ,percussion etc…. • ***SWABS throat or nose –To help to identify any viruses…. • *** LAB INVESTIGATIONS – CBC, pleural fluid analysis Etc….. • *** CHEST X RAY or CT CHEST – To determine if there is fluid in the air sacs of the lungs

  7. TREATMENT OF ARDS - >.ANTIBIOTICS >.BLOOD THINNING MEDICATIONS OR AIDS – Example-heparin , compression stockings ( to reduce the risk of clots ) >.NUTRITION SUPPORT –To maintain Normal micro & macro nutritional balance ….. >.OYGEN THERAPY – based on severity NASAL CANULLA—FACE MASK– NRBM—HFNC—BIPAP- NIV—INTUBATION etc……

  8. ARDS MANAGEMENT • TREATMENT OF ARDS ,IT SHOULD MAINLY INCLUDES- • ** Treating underlying cause ex-sepsis,Diabeticketo acidosis, nutritional balance etc….. • **Lung protective ventilation ( low vt+adequate PEEP) • **Avoid a positive fluid balance • However , in severe cases of ARDS(low PH , low o2 & high co2 & increasing PEEP Pressure )standard therapy may fail….. • Main Rescue therapy is PRONE POSITIONING ……

  9. BASED ON PF RATIO , ARDS MANAGEMENT PROTOCALS **INCREASING PEEP & FIO2 –if PF ratio dropped less than <300mmhg… ** PRONE POSITIONING IF pf ratio falls below than <200mmhg… ** ECMO ( V-V TYPE OF ECMO)- if pf ratio falls below than <75mmhg.. **Lung transplantation –because of more complications& difficult feasibility , generally not practicing…….

  10. PRONE POSITIONING ….. • MAIN INDICATIONS- • ** ARDS • ** <48HRS ONSET HISTORY • ** PF RATIO <200MMHG • RELATIVE CONTRAINDICATIONS FOR THE PRONE POSITIONING- • Elevated ICP, Intestinal ischemia,obesity,recent abdominal surgery • ABSOLUTE CONTRAINDICATIONS FOR PRONE POSITION- • Spinal cord, instability,unstagable facial fracture,anterior burns, open abdomen , increased abdominal pressure , unstagable pelvic fractures….

  11. PRONE POSITION- • Indicated – • Moderate to severe ARDS • Early (48hours of ARDS) • DURATION – based on intensivist order ,Usually 12-20hours is recommended…. Prone position improves- **improves perfusion to the lungs **the diaphragm drops & heart shift forward—improved compliance **improves lung recruitment **lung protective …

  12. PRONE POSITIONcont…… • **may lowers airway pressure • **may improve VT & MV (DECREASES CO2) • **Reduce the risk of atelectotrauma,barotrauma &volutrauma…. • RECOMMENDED CYCLES- • As per physician or intensivist advice usullay 6-14cycles ( based on response)…..

  13. PRONE POSITION NURSING CARE- Ensure adequate sedation & analgecia ( meet goal RASS ) … • Securing of all lines & tubes , so avoid interruptions…. • ABG PRN to assess oxygenation ( pao2) & ventilation ( paco2) & VBG once daily …. • Reposition of arms 2nd hourly … • Head position changing 4th hourly… • Nutrition –minimal feed therapy 10-20ml/hr , to reduce the risk of aspiration & parenteral nutritional therapy …. • Check q2h for pressure areas …. • Family education ….

  14. NURSING MANAGEMENT • SPECIAL CONSIDEARTIONS-while handling proned patients • **monitor vital signs & urine out put…. • Minimal NGT or OGT feed ( avoid aspiration) …. • check frequently plateu pressure & Ppeak in ventilator ( et tube free from secretions) • **Frequant head position & arms postion changing .. • **approach doctors for daily chest X ray &electrolytes corrections as per intensivist……. • *ABG IS MUST & SHOULD DO ; 1 HOUR BEFORE PRONE & 1HOUR AFTER THE PRONE ”….ABG MUST & SHOULD DO ; ONCE SUPINED NEED TO DO WITHIN 1 TO 4 HOURS… • 6TH HORLY ABG ,DAILY RFT NEEDED AS PER PHYSICIAN ORDERS …

  15. THANK YOU ALL

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